Inactivated viruses (vaccines).

Hepatitis A virus

Each vial or syringe contains 1440 ELISA units/1 ml dose of hepatitis A virus antigen

Vaccine suspension for injection.

Active immunisation against infections caused by hepatitis A virus. The vaccine is particularly indicated for those at increased risk of infection or transmission. For example immunisation should be considered for the following risk groups: travellers visiting areas of medium or high endemicity, i.e. anywhere outside northern or western Europe, Australia, North America and New Zealand, military and diplomatic personnel, haemophiliacs and patients, intravenous drug abusers, homosexual men, laboratory workers working directly with the hepatitis A virus, sanitation workers in contact with untreated sewage. Patients with chronic liver disease (including alcoholic cirrhosis, chronic hepatitis B, chronic hepatitis C, autoimmune hepatitis, primary biliary cirrhosis). close contacts of hepatitis A cases.

Since virus shedding from infected persons may occur for a prolonged period, active immunisation of close contacts may be considered. Under certain circumstances additional groups could be at increased risk of infection or transmission. Immunisation of such groups should be considered in the light of local circumstances.

Such groups might include: staff and inmates of residential institutions for the mentally handicapped and other institutions where standards of personal hygiene are poor. staff working in day care centres and other settings with children who are not yet toilet trained. food packagers or handlers. In addition there may be other groups at risk or specific circumstances such as an outbreak of hepatitis A infection when immunisation should be given.

Posology

Adults (16 years and over)

Primary immunisation consists of a single dose of Havrix Monodose vaccine (1440 ELISA units/ml) given intramuscularly. This provides anti-HAV antibodies for at least one year.

Havrix Monodose confers protection against hepatitis A within 2-4 weeks.

In order to obtain more persistent immunity, a booster dose is recommended between 6 and 12 months after primary immunisation.

Although a booster should be given within 6 – 12 months of the initial vaccination with Havrix Monodose, it has been shown that immunocompetent subjects given a booster up to 3 years after the initial vaccination can develop similar antibody levels to subjects given a booster within the recommended time period. Subjects given a booster up to 5 years after initial vaccination can also show a satisfactory antibody response but approximately 30% of individuals receiving a delayed booster have no detectable anti-HAV antibodies prior to booster dosing.

It is unnecessary to restart the primary vaccination schedule of Havrix Monodose if the booster is administered within 5 years of the primary vaccination.

Current recommendations do not support the need for further booster vaccination among immunocompetent subjects after a 2 dose vaccination course.

The results described above should be considered to apply only to immunocompetent adults.

Havrix Monodose can be used as a booster in subjects previously immunised with any inactivated hepatitis A vaccine.

In the event of a subject being exposed to a high risk of contracting hepatitis A within 2 weeks of the primary immunisation dose human normal immunoglobulin may be given simultaneously with Havrix Monodose at different injection sites.

Havrix Monodose is not recommended (Havrix Junior Monodose should be used).

Method of administration

Havrix Monodose vaccine should be injected intramuscularly in the deltoid region.

The vaccine should never be administered intravenously.

Hypersensitivity to any component of the vaccine. Severe febrile illness.

As for all vaccinations, appropriate medication e.g.epinephrine (adrenaline) should be readily available for immediate use in case of anaphylaxis. Havrix Monodose may contain traces of the antibiotic neomycin B sulphate.

It is possible that subjects may be in the incubation period of a hepatitis A infection at the time of immunisation. It is not known whether Havrix Monodose will prevent hepatitis A in such cases.

In haemodialysis patients and in subjects with an impaired immune system, adequate anti-HAV antibody titres may not be obtained after the primary immunisation and such patients may therefore require administration of additional doses of vaccine.

Simultaneous administration of Havrix at a dose of 720 ELISA units/ml with ISG does not influence the seroconversion rate to Havrix, however, it may result in a lower antibody titre. A similar effect could be observed with Havrix Monodose.

Preliminary data on the concomitant administration of Havrix at a dose of 720 ELISA units/ml, with recombinant hepatitis B virus vaccine suggest that there is no interference in the immune response to either antigen. On this basis and since it is an inactivated vaccine interference with immune response is unlikely to occur when Havrix Monodose is administered with other inactivated or live vaccines. When concomitant administration is considered necessary the vaccines must be given at different injection sites.

Havrix Monodose must not be mixed with other vaccines in the same syringe.

These are usually mild and confined to the first few days after vaccination. The most common reactions are mild transient soreness, erythema and induration at the injection site. Less common general complaints, not necessarily related to the vaccination, include headache, fever, malaise, fatigue, nausea, diarrhoea and loss of appetite and rash. Arthralgia, myalgia, convulsions and allergic reactions including anaphylactoid reactions have been reported very rarely. Elevations of serum liver enzymes (usually transient) have been reported occasionally. However, a causal relationship with the vaccine has not been established.

Neurological manifestations occurring in temporal association have been reported extremely rarely with the vaccine and included transverse myelitis, Guillain-Barre syndrome and neuralgic amyotrophy. No causal relationship has been established.

GlaxoSmithKline(GSK)

(POM)

22 June 2009